Quality of Life in Non-Hodgkin Lymphoma: A Comparison Between Survivors of Indolent and Aggressive Disease.

Few studies have examined the functional limitations, physical health, mental health, and general quality of life in cancer survivors with various types of non-Hodgkin lymphoma (NHL). Patients with aggressive NHL (AGG) require immediate chemotherapy for a potentially curable disease in contrast to patients with indolent NHL (IND) that is characterized by a chronic course with repeated relapses and progression despite therapy. This study examined the QOL in adult survivors of NHL >1 year from diagnosis and not currently on therapy; we hypothesized that fatigue and quality of life would be worse in patients with low grade NHL given the expectation of future progressive disease and repetition of multiple therapies.

109 patients with NHL (58 AGG, 51 IND), more than one year from initial diagnosis, and at least three months from any active therapy, completed two health related quality of life assessments using the Medical Outcomes Study 36-Item Short-Form Healthy Survey (MOS SF-36) which assesses 8 subsets and 2 summary scores, and the Functional Assessment in Cancer Therapy – Fatigue (FACT-F). Physical and Mental SF-36 scores or FACT-F scores between IND and AGG were compared using a two sample t-test. Multiple linear regression* was performed to account for any potentially explanatory variables (age, use of chemotherapy, time from last treatment to survey).

Median age was 60 years [61 years (33-88) IND and 57 years (22-90) AGG]. 48.6% were female (52.9% IND, 44.8% AGG). 74.3% were in complete remission at the time of the survey (52.9% IND, 93.1% AGG) (p<0.001). 70.6% had received chemotherapy (43.1% IND, 94.8% AGG) and 55% had received immunotherapy (31.4% IND, 75.9% AGG). 17.6% of IND had received no therapy. The overall physical (PCS) and mental (MCS) component quality of life scores of the SF-36 did not differ between survivors with aggressive and indolent NHL; the median PCS was 51.8 (11.2-66.5) [56.8 IND, 51.4 AGG, p=0.192] and the median MCS was 54.2 (10.8-65.8) [54.6 IND, 53.3 AGG, p=0.239]. Examining the eight subcategories of the SF-36, physical function in survivors of IND was significantly better when compared with those of AGG NHL. Using the FACT-F, fatigue scores also did not differ between the two populations; the median FACT-F score was 45 (8-52) [47 IND, 43 AGG, p=0.114).

While some other studies have reported a decreased quality of life in NHL survivors, our study reports a similar overall quality of life between survivors of IND and AGG NHL more than one year from initial diagnosis; this may be explained by a significant proportion of our IND patients having never received therapy or an acclimation to the need for future therapy. Physical function may be more impaired in survivors of AGG NHL and warrants further investigation.

No relevant conflicts of interest to declare.